How do you feel about continuity of care in midwifery

[RosieLemonade]

Sorry if my title is a little clunky. I saw my 2nd midwife this pregnancy a few weeks ago (16 week appointment). She told me this was the last time she would see me as they were switching to a continuity plan and she was moving to another pratice. She said I would have 8 midwives in a team and one of them would be there for delivery. I would rather have one midwife the whole way through and then a stranger deliver the baby. I had severe mental health issues during my first pregnancy and feel consistentancy would help with them! Also I had to explain this to both midwives and tell the second one I was consultant led as she didn't even know! I've also read midwives are not happy about the changes. What are your thoughts and experiences?

@CharlottesWebinar I said none of us (as in my team) are happy with it. Another midwife has said 99% of their team are unhappy with it. It doesn’t work. Yes it works in teams where midwives self select to run a caseload but when you have a team of semi retired, part time etc it’s impossible. Add into that covid isolations, normal sickness, burnout. We are losing midwives faster than we can train them. How is this better?

In previous pregnancies I have had several appts with 1midwife with a scattering of other people. This time it was with 1 midwife (except 1 time she was ill). Unfortunately she has left for a different post, so now changing (but will see the other person who filled in for her when she was ill; and then the person taking over from her).

So it’s been a good experience for me. I do have her mobile number, so I can ask quick questions by text (eg - is my blood result back etc). For me the continuity model has worked - I did ask one midwife what she thought about shift pattern etc. She said that she had flexibility to organise her own day (presumably when she is in community), so it worked for her. But I believe we have a shortage of midwives and making things work for them and their families is also important.

I have a couple of medical conditions, so it is helpful not having to repeat myself each time I meet someone new.

I could be pedantic and point out you said ‘none of us’ without adding ‘in my team’. And 1 other stating 99% of their team is also a very small number. I could also point out that 100% of the midwives I know who work in an effective model are perfectly happy, but again, in the grand scheme of things this is a very small number.
But that would not be helpful and it would not be supportive. Midwives need choices on how they work and the current nhs system, climate and culture it is not the best time to be forcing change.
You cannot argue with proven outcomes though so yes, it is better, however impossible it may be to actually do it.

There was a thread running on here a few days ago where continuity was being discussed with a lot of midwives saying very similar- essentially that complete continuity is a nice idea but the staffing needed to run it is way above what's currently available with retention issues (some caused by a move to continuity) within the profession.

I was told I would have continuity this time, couldn't see how it would work and sure enough it hasn't panned out that way at all. The MLU is closed due to staff shortages never mind continuity on top but it still seems to being pushed in my trust.

My first pregnancy, same trust, much better staffing just nobody allocated to my GP practice as 'mine' was on leave. I saw someone different each time and then antenatal, delivery and postnatal were all different teams. I did see the same midwife for my home visits after birth which was nice. Didn't feel short-changed or concerned by this at all!

Long story short on the other thread I was saying I'd much rather have a well-staffed and not hideously overworked team at each point, everyone I've ever had involved in my maternity care has been professional, friendly and effective. If continuity is causing changes in work patterns which is then leading to a staffing crisis, as those midwives were saying on the other thread, I can't possibly support it as a 'customer'. There has been research to show it leads to better out ones and there was a discussion about applying it in high needs situations but for someone like me I just want whoever is caring for me to be enabled to be effective and comfortable in their work. If the majority of those in the profession say that it's unsustainable at present then the staff shortages need addressing way before such a staff-intensive model gets rolled out, duty?

However the idea of community continuity then with a different team in hospital sounds like it's the one that works best for most purposes, listening to what people have been saying, so that's a good compromise I'd have thought?

@CharlottesWebinar Doing it properly and as per your figures yes it’s better as it’s safer. The actual reality of what happens with the half hearted attempted and women getting worse continuity then they did before we had continuity is certainly not better!

I'm a community midwife so I see women for all antenatal and postnatal checks but the hospital midwife will deliver them

This was my experience in my first pregnancy and I didn't mind it at all. I think I saw the same MW a couple of times in pregnancy and then postnatal. That was 5 years ago.

Second pregnancy was at a satellite clinic for the hospital I delivered at but was a sad outcome. Because of that, any care I have in subsequent pregnancy will be under the hospital bereavement MWs, a team of 3 who I know. I'm not suggesting that this is the best route to get continuity of care, in fact, I couldn't recommend it less.

I was very fortunate to have full continuity of care for my second and third pregnancies through the One to One midwife service. Sadly it has now gone bust and is no more. I had a traumatic first birth (crash section, week in hospital, difficulties breastfeeding) and having a dedicated midwife I believe gave me the opportunity and confidence to have two subsequent uneventful vaginal deliveries. I requested the same midwife for my third baby so I actually had the same midwife for all my antenatal appointments and both deliveries.
It was fabulous for me, and my midwife was amazing, but she was run ragged and frequently worked back to back days having been up all the intervening night delivering a baby so for the model to work you would need enough midwives to enable timing of births and workloads to be realistic and not ridiculous, and I can't see that happening.

I couldn't care less about continuity. I saw a whole team of midwives antenatally and a few different ones during labour. It was only after being on MN and people started talking about "my midwife" and trying to contact this one person that I had any idea this was a thing.

I've got no interest in building a relationship with anyone I'm seeing medically. I'd like all appointments to be friendly and efficient but I see no benefit at all to needing the person who checks my blood pressure from one week to the next to be the same person.

It would be money better spent have a dedicated second tier of service so anyone with physical, mental or social additional care requirements gets gets the appropriate follow up and the rest of us can just use an efficient team of midwives at each stage.

For me personally it doesn’t bother me seeing someone new each time. Certainly didn’t give a hoot while in labour and at the birth as was too zoned out.

I can see why people would prefer same one all the way through though

I have seen someone different almost each appointment and it is a bit frustrating. There have been great midwives and grumpy ones, patient ones and patronising ones. Of course I’m anxious about who I’ll get for the birth.
But at least I don’t have the anxiety of knowing in advance I’m stuck with someone I don’t trust….

@emsyj37

I was very fortunate to have full continuity of care for my second and third pregnancies through the One to One midwife service. Sadly it has now gone bust and is no more. I had a traumatic first birth (crash section, week in hospital, difficulties breastfeeding) and having a dedicated midwife I believe gave me the opportunity and confidence to have two subsequent uneventful vaginal deliveries. I requested the same midwife for my third baby so I actually had the same midwife for all my antenatal appointments and both deliveries. It was fabulous for me, and my midwife was amazing, but she was run ragged and frequently worked back to back days having been up all the intervening night delivering a baby so for the model to work you would need enough midwives to enable timing of births and workloads to be realistic and not ridiculous, and I can't see that happening.

One to One were amazing! They sadly went bankrupt as the amazing service they offered just wasn’t affordable on the NHS funding they received.

This is why it simply doesn’t work the same in the NHS. Not enough midwives and not enough money. Until we fix that it will only ever a half hearted attempt that does nothing to improve outcomes or quality of care.

The midwives I work with are not against continuity of care. They are against it in its current format that simply doesn’t work.

This new system of continuity seems crazy.

I have had 2 babies.

With my first I found my community midwife very 'relaxed' about any concern, answering calls or passing o. Test results even when I had infections and always atleast 30 to 60 mins late for appointments - even the first one of the day. Frankly I was relieved she wasn't going to deliver the baby.

With my second - again named midwife who i saw from start to day 10 appointment - I loved have the same person. This was my third attempt after two lost babies which she knew about. She answered calls, she responded to text messages, she supported me when my toddler caught covid at the end of my pregnancy. I don't think I would have got this care from a team of shared midwifes.

So no I don't see this new approach as being better care.

Frankly when you get to labour - it's almost a separate process?

Last time I had the same midwife the whole way through. She wasn't great but she knew me and my anxieties. I obviously didn't expect her to deliver the baby! This time I have already had two midwives. I don't have that many appointments left really. Just seems a bit pointless to meet all these midwives when if I've only met someone twice for 15 minutes what difference is that to someone I've never met delivering?

I've had 4 midwife appointments so far, each time with a different midwife.
The 4th was actually my allocated midwife.

I don't mind at all, they have all been friendly and professional and perhaps more surprisingly (considering what I'd read here and heard from others) none have been negative about my ELCS and they've actually been positive about it.

The staffing is not available and while we should all expect good quality care as a minimum, it's unrealistic to expect continuity as in seeing the same person.

I was allocated a named midwife based on my due date but I only saw her twice during my pregnancy. I have since seen three different ones. My original midwife told me to contact her if I needed anything so I tried and had no response - I called the team as I wasn't being given weekly appointments during my last few weeks of pregnancy. Eventually, she messaged back saying she'd taken time off for personal reasons (I feel the team could have communicated that she was off work and kept it as vague as that) and was going to leave the community team to go back to the labour ward so I would have a new named midwife. However, it was always possible that my named midwife wouldn't be there at the birth because the baby can come whenever. For me, I guess it matters less because I'm having an ELCS so I don't need the continuity - if I was going for a vb, I would want a familiar face there so I do empathise with you but I also recognise that the midwife may not be available when baby decides to make an appearance.

I had one community midwife throughout. We didn't get on.
I organised my own amino and they were lovely, saw my gp a couple of times, also lovely and then delivered in hospital with three midwives who I had never met before. They were great.

Having only one midwife left me unsupported, barely tolerating a rude, arrogant dictatorial woman who had never had a baby herself, in my house. Until on my due date when I told her to go away and stop twitching

Having a team would have been better.

It is really different in each trust. I have had three in three different NHS trusts. First had a team of midwives and I always saw one of the 5. One was there when I had my DD.

With my second I had a midwife I saw at my GP practice but also an array of random midwives at the hospital.

Third time (and my favourite) I saw the same midwife from booking until 39 weeks. Then at my c section I had a new midwife I had never met before.

My younger child was born 8 years ago. Mostly I saw the local midwife... except one appointment she was on leave so her appointments were covered by someone else in the community team. Then at 36 weeks I had a slight complication meaning I needed daily visits... I saw whoever was available that day to visit me for the next couple of weeks.

She was born at home with midwives I had met briefly on those home visits. If I had gone into labour a couple of hours later it would have been "my" midwife.

I quite liked that model. It couldn't have been done with a 1-1 service. A small team was nice... however this was a rural area and they covered a vast area. The nearest hospital was 40 minutes away (and only had a MLU... anything more complicated was an hour at least).

Personally for me I prefer the same midwife all the way through and then I don't care who's there during labour. My last labour was so bad, I had one of the Drs puncture my spine, I needed three surgeries etc. My daughter even got ill on the postnatal ward due to the midwifes neglect.

I gave birth in May so really recent. I'm currently pregnant again and have already seen two different midwives, they've told me I won't see the same midwife each time. Even though they have my notes this means I'll have to explain the severity of what happened last time over and over again and it's getting annoying.
Luckily I'm Consultant led so there's some consistency there as their the ones I make the big decisions with but still

In my second pregnancy now.

In my first pregnancy, I had most of my antenatal appointments and about half my postnatal ones with the same midwife, and then midwives I'd never met before for the delivery (think one was a student). To be honest I didn't especially like the midwife I mainly saw antenatally. She missed a condition I had which this time around I am seeing a consultant for and she also told me off for gaining too much weight (22lbs by 36 weeks!). I wouldn't have wanted her at my birth, particularly.

I didn't mind at all that I'd never met the midwives at my delivery before. They were kind, professional and listened to me, and I felt safe with them. I didn't need to be best friends with them really - I was somewhat preoccupied by the whole giving birth thing...

I absolutely loved the continuity of care team in my area. I saw the same midwife for all but one appointment when she was on leave. At several of the appointments a second midwife from the team was there so she got to know more of the ladies. This second midwife happened to be the one covering labour ward when I was taken to have my waters broken and the midwife who covered the one appointment where my usual midwife was on leave delivered my baby (shift change just before waters were broken). As an anxious person, I was so much happier this pregnancy at the level of care and continuity of staff (previous pregnancy there wasn't a team). It was so lovely in labour that both the midwifes I saw were familiar, knew my notes well and also both visited me at home. When I was on the induction suite for a few days my regular midwife popped in to see me while she was on her hospital shift which was lovely and I got an extra home visit so that she could see baby (she was on leave for the first 14 days so I was kept on until 21 days when she was back). I know areas might vary but round here it really was great, I felt like I got to know the midwives so much better

I saw different midwives throughout my pregnancy. I'd never before met the midwives that I had during my labour and there was a shift change in the middle of my labour too, just when things were really kicking off after a long night.

For me personally it didn't matter. I found that I built up a relationship with them all very quickly given the situation we were in. Everyone I met was amazing, well qualified and helped me to feel safe although I had a lot of complications.

I had an interesting take on continuity today, 'my' midwife is on leave so will miss my postnatal appointments this week, no problem. However it was so nice today that the lady covering is the one that did my postnatal for our older DD and was able to say hello to her too.

THAT to me is what is like to see in terms of continuity- the local team being settled and staffed in such a way that they are retained and you see a small selection of people for the community stuff.

When it came to labour I couldn't tell you who was looking after me for most of it as I was just trying to get through it, and they were getting me through it. So the model of a community team and a set of hospital teams definitely ticked the box for me this last week, I don't think having 'my' midwife around would have done much differently other than I perhaps wouldn't have been begging for something better than paracetamol when I was sitting at 6cm on the antenatal ward...

@SpangoDweller

I had antenatal appointments and postnatal visits with a team of 4-5, and probably saw each one twice. Hospital midwives were a different team entirely.

This is currently the system I'm in. Did occur to me other places in the UK had a different way of doing things. And honestly I couldn't care one bit as long as each midwife I see is nice, competent and qualified.